What's Up Doc? Precautionary advice for travelers

Tuesday

Mar 4, 2014 at 7:26 PMMar 4, 2014 at 7:26 PM

Q: My church group is going on a mission to Guatemala. What preparations should we make?A: Many things can be done to help ensure a travelerís health and safety. See your healthcare provider (HCP) well before your planned departure date.n Get evaluated to be sure you are in good enough health for your trip.n Your measles-mumps-rubella (MMR), diphtheria-tetanus-pertussis (DTP), chicken pox, polio, flu and any other routine vaccinations your HCP recommends should be up to date.n Hepatitis A can be acquired by ingesting contaminated food or water. Two doses of hepatitis A vaccine are recommended, one on day zero and the second six to 12 months later; there is benefit even if you can only get the first shot before you leave.n Typhoid is also acquired via ingestion of contaminated food or water. The oral vaccine only requires a booster every five years (as opposed to every two to three years for the shot vaccine) and is taken in four doses, two days between each dose.n Hepatitis B can be transmitted by exposure to blood, contaminated needles or sexual contact. Since an injury possibly requiring treatment (e.g. blood transfusion) is possible, travelers should strongly consider getting vaccinated for hepatitis B. The series of three shots is given day zero, at one month and at six months; but even if you can only get the first two shots before you leave there is benefit.n Travelers at high risk of an animal bite (e.g. planning to work with animals or hike in rural areas) may be advised to have rabies vaccination, a series of three shots (day zero, seven and 21 to 28). Note that other treatment after rabies exposure is still required.n Malaria is endemic in Guatemala in areas lower than 5,000 feet. If you will be in high-risk areas, you should speak to your HCP about possibly taking malaria prophylaxis medication.n Bring a sufficient quantity of any prescription medications, and ask your HCP to recommend over-the-counter medications, a first aid kit and other treatments that may be useful to bring.Avoid insect bites; many diseases can be transmitted by insects including malaria, dengue fever, Chagas disease (actually transmitted by the feces of "kissing bugs" and not their bite) and others.n Use insect repellent with greater than 20 percent DEET since this will be effective for up to several hours.n Cover exposed skin by wearing long sleeves, pants and a hat.n Consider treating your clothing with permethrin to help repel insects.n Sleep in an air-conditioned room or use a mosquito net.n Check daily for ticks; if any are found remove them by grasping them with tweezers as close to the skin as possible and gently pull with even upward pressure, then thoroughly clean the area.Avoid contaminated food and water:n Consume hot, freshly prepared, well-cooked foods. You can eat fruits/vegetables if they are well cleaned with treated water and you peel them yourself.n Drink plenty of fluids (to avoid dehydration) such as carbonated drinks or bottled, boiled or treated water. Avoid ice unless you are sure it is made from bottled or treated water.n Avoid unpasteurized milk, undercooked foods, food from street vendors, wild game or other suspect foods.Follow general safety rules:n Let someone back home know your travel plans.n Carry paperwork with your medical information (including any conditions you have, medications you take and contact numbers back in the states), a copy of your passport and vaccination records.n Travel with others; avoid deserted areas, and do not go to non-public places with someone you just met.n Take scheduled transportation or hire a reputable service.n Use sunscreen.n Swim only in designated safe areas to protect you from drowning and to avoid exposure to diseases that can be transmitted in fresh water (such as lakes, rivers, ponds).n Wear shoes on the beach; there are certain diseases that can be transmitted through the skin from contact with contaminated sand.n Avoid contact with animals, especially wild or unknown animals.n Wash your hands frequently; soap and water is best, but hand sanitizer is a backup plan.n Pack lightly; do not bring expensive items, and do not bring anything irreplaceable.Have a backup plan:n Consider insurance to pay for medical evacuation if it is needed.n If you do get sick there are some excellent hospitals in Guatemala; call the U.S. Embassy to get further information.n Consider enrolling in the Smart Traveler Enrollment Program (https://step.state.gov/step/).Travel to Guatemala, the Land of Eternal Spring, can be fun and rewarding. Take the appropriate precautions, but do not let the need for safety scare you from your travel plans!Jeff Hersh, Ph.D., M.D., can be reached at DrHersh@juno.com.